Idiopathic Edema Research Articles

Hyaluronidase injection for the treatment of eyelid edema: a retrospective analysis of 20 patients.

BackgroundHyaluronidase (Hylase Dessau®) is a hyaluronic acid-metabolizing enzyme, which has been shown to loosen the extracellular matrix, thereby improving the diffusion of local anesthetics. Lower eyelid edema is a common post-interventional complication of cosmetic procedures performed in the lid region, such as the injection of hyaluronic acid fillers for tear-trough augmentation. The purpose of this study was to validate the efficacy of hyaluronidase in the management of lower eyelid edema.MethodsWe performed a retrospective analysis with 20 patients with lower eyelid edema. Most patients (n = 14) presented with edema following hyaluronic acid injection (tear-trough augmentation), whereas the minority (n = 6) were treated due to idiopathic edema (malar edema or malar mounds). Patients were treated by local infiltration of approximately 0.2 ml to 0.5 ml of hyaluronidase (Hylase Dessau® 20 IU to 75 IU) per eyelid. Photographs were taken prior to and seven days after infiltration.ResultsHyaluronidase was found to reduce effectively and rapidly or resolve eyelid edema after a single injection. No relevant adverse effects were observed. However, it must be noted that a hyaluronidase injection may also dissolve injected hyaluronic acid fillers and may therefore negatively affect tear-trough augmentations. While the effects of a treatment for edema due to tear-trough augmentation were permanent, malar edema and malar mounds reoccurred within two to three weeks.ConclusionThe infiltration of hyaluronidase is rapid, safe and currently the only effective option for the management of eyelid edema. No relevant adverse effects were observed.

Ultrasound imaging of the “on call” acute scrotum

Causes of the acute scrotum1. Vascular– Spermatic cord torsion– Torsion of the appendix testis2. Trauma– Testicular rupture/fracture– Haematoma/haematocele– Penetrating injury3. Infective/Inflammatory– Epididymitis/epididymo-orchitis– Testicular abscess– Fournier’s gangrene4. Miscellaneous– Acute idiopathic scrotal oedema– Inguinoscrotal hernia– Testicular tumours– Henoch–Schonlein purpuraTorsion of the spermatic cord– Is a surgical emergency—irreversible ischaemia occurs after 6 h– Represents 17% of all acute scrotal presentations, the incidence is 1 in 4000 males– Intravaginal torsion is associated with the bell-clapper deformity. Presentation is most commonly between the ages of 12–18 years– Extravaginal torsion is rare and occurs in utero or the perinatal period, the testis is usually unsalvageable– Greyscale ultrasound may be normal in immediate post-torsion period. Following this, sonographic changes frequently mimic acute epididymo-orchitis.– Lack of flow or diminished flow on colour/power Doppler ...

Mood‐dependent changes of serum lithium concentration in a rapid cycling patient maintained on stable doses of lithium carbonate

Serum lithium levels may be influenced by mood state. We report on a 58-year-old female patient suffering from rapid cycling bipolar disorder. Her serum lithium levels varied greatly, despite stable medication. The patient was observed over a one-year period. The patient received a stable medication of lithium carbonate (450 mg), valproate (1500 mg), and clozapine (200 mg). Investigating mood and serum lithium levels over one year revealed six manic and six depressive phases. The mean lithium serum level was 0.67 mmol/L in the depressive states, 0.39 mmol/L in the manic states (t = 4.11, p = 0.001 versus depression), and 0.40 mmol/L in the euthymic states (t = 3.58, p = 0.003 versus depression). Noncompliance was ruled out. The patient gained up to 8 kg during manic phases, accompanied by pretibial edema. Changes in serum lithium concentration are probably not caused by altered lithium, but by water metabolism. During mania, body water increases, leading to dilution and therefore a reduction in serum lithium levels. As there is no proof for any other known cause of hypervolemia, we propose the hypothesis that the increase in body water is due to a variant of idiopathic edema.

Comparison of lymphoscintigraphy and indocyanine green lymphography for the diagnosis of extremity lymphoedema

Lymphoscintigraphy is the gold-standard examination for extremity lymphoedema. Indocyanine green lymphography may be useful for diagnosis as well. Wecompared the utility of these two examination methods for patients with suspected extremity lymphoedema and for those in whom surgical treatment of lymphoedema was under consideration. A total of 169 extremities with lymphoedema secondary to lymph node dissection and 65 extremities with idiopathic oedema (suspected primary lymphoedema) were evaluated; the utility of indocyanine green lymphography for diagnosis was compared with lymphoscintigraphy. Regression analysis between lymphoscintigraphy type and indocyanine green lymphography stage was conducted in the secondary lymphoedema group. In secondary oedema, the sensitivity of indocyanine green lymphography, compared with lymphoscintigraphy, was 0.972, the specificity was 0.548 and the accuracy was 0.816. When patients with lymphoscintigraphy type I and indocyanine green lymphography stage I were regarded as negative, the sensitivity of the indocyanine green lymphography was 0.978, the specificity was 0.925 and the accuracy was 0.953. There was a significant positive correlation between the lymphoscintigraphy type and the indocyanine green lymphography stage. In idiopathic oedema, the sensitivity of indocyanine green lymphography was 0.974, the specificity was 0.778 and the accuracy was 0.892. In secondary lymphoedema, earlier and less severe dysfunction could be detected by indocyanine green lymphography. Indocyanine green lymphography is recommended to determine patients' suitability for lymphaticovenular anastomosis, because the diagnostic ability of the test and its evaluation capability for disease severity is similar to lymphoscintigraphy but with less invasiveness and a lower cost. To detect primary lymphoedema, indocyanine green lymphography should be used first as a screening examination; when the results are positive, lymphoscintigraphy is useful to obtain further information.

Cardiopulmonary Consequences of Post Thoracic Surgery Pulmonary Hypertension: Cause or Consequence of Lung Edema?

The major complication of post-thoracic surgery is a severe disturbance of lung extravascular water that is the main cause of morbidity and mortality and therefore still represents an unmet medical challenge. Accordingly, the need to devise novel therapies ought to go through a more thorough understanding of the pathophysiological mechanisms. This review presents an updated description of the time evolution of this process providing the pathophysiological reason for its explosive development. Despite various names (“idiopathic edema”, acute lung injury -ALI, atelectasis, ARDS), a common patho-physiological pathway can be traced for respiratory dysfunction in post-operative thoracic surgery. We will present the evidence for the loss of control on the volume of extravascular lung water from the new perspective of the derangement and disorganization of interstitial proteoglycans, a family of link molecules controlling microvascular permeability and mechanical stability of the extravascular matrix. We analyze in detail specific conditions of lung water disturbance pertaining to cardiac surgery, lung transplant and lung resection surgery. In particular, we will discuss the functional link between lung edema formation and increase in pulmonary vascular resistances, and wish to develop the concept that pulmonary hypertension and right ventricle overload ought to be regarded as the consequence of a decrease in vascular bed reflecting microvessels compression in the edematous tissue both in the acute phase as well as in the fibro-proliferative repair process.

A Case of Genitourinary Crohn's Disease

Scrotal swelling in young boys is a common problem. The differential diagnosis includes testicular torsion, epididymoorchitis, and idiopathic scrotal edema. We report the unusual case of a 17-year-old boy who presented with recurrent episodes of penile and scrotal edema as extraintestinal manifestations of Crohn's disease. Genitourinary complications of Crohn's disease are not uncommon; however, they more typically present in the form of nephrolithiasis, obstructive uropathy, and enterovesical fistulization. Few reports have described Crohn's disease presenting with isolated genital edema in the absence of associated intestinal or systemic symptoms.

Perception of salty taste and preference to sodium chloride

Sodium chloride is the main food additive contributing to salty taste. It also has preserving effect and participates in acquiring desirable textural characteristics and properties of the food. Main role of sodium in human organism is presented in this paper, as well as mechanisms of the regulation of sodium metabolism and negative effects of excessive intake of sodium. Excessive sodium intake is one of the causes of essential hypertension as direct risk of myocardial infarction, left ventricular hypertrophy, clinical and idiopathic edema, reduced elasticity of blood vessels, proteinuria, risk of coronary and kidney disease, risk of stomach cancer, incidence of renal celluloses, decreased bone density, exacerbation of asthma attacks, increased insulin resistance and incidence of obesity. Also, in this paper, development of the sense of taste is presented, neural regulation of the taste for salt, as well as development of preference to salt occurring in early childhood and transmitted through adolescence to adulthood, which may have lifelong implications. Reduced intake of salt, compared to usual intake available through food, can have long lasting effects and at the same time, it can develop the sense of taste in children in a way that they consume food with less sodium chloride as adults. Studies in this field are very limited, but it is important to point out that exposure to salt in the early years of life greatly determines the preference to salt in the adulthood, which is important from the aspect of, either preservation, or health impairment, depending on the sodium intake.

Non‐Surgical Periodontal Therapy Improves Serum Levels of C‐Reactive Protein and Edematous States in Female Patients With Idiopathic Edema

The relationship between periodontal disease and systemic disease is revealing new and exciting associations. Idiopathic edema presents a clinical syndrome with obscure pathophysiology. The present study investigates whether non-surgical periodontal therapy is beneficial in patients who are not responding to conventional treatment of idiopathic edema. Thirty patients with idiopathic edema were allocated to intervention and control groups. All the subjects were assessed for systemic (body weight, body mass index, visual scale of edema, serum C-reactive protein, and serum albumin) and periodontal (plaque index, calculus index, and gingival index) parameters. Non-surgical periodontal therapy, including oral hygiene instructions, scaling and root planing, and systemic antibiotic therapy, was provided in the intervention group. Both groups were reevaluated after 4 weeks. Both groups were comparable at baseline. All parameters, except serum albumin, showed significant improvement after periodontal therapy. The control group showed further worsening of these parameters. This study shows that sources for systemic inflammation, such as periodontal disease, could affect the pathogenesis of idiopathic edema. Successful elimination of such covert sources of inflammation leads to a clinical benefit in patients who are distressed by this condition.

La torsione del funicolo spermatico: criticità cliniche e medico-legali

[ Torsion of the spermatic cord: clinical and medicolegal critical states] Although an exhaustive statistics is not available nowadays, the torsion of the spermatic cord is a common cause of medical-legal contentious. This is due to the diversified symptoms, to the difficult differential diagnosis (e.g.: epididymitis/acute orchiepididymitis, torsion of testicular appendixes or of epididymis, strangulated hernia, hematocele, hydrocele, testicular neoplasia, symptomatic spermatocele and idiopathic scrotal oedema) and to the importance of a sudden therapeutic intervention (within few hours): in fact a late intervention leads to testicular necrosis and subsequently to orchiectomy. The article shows also the different classifications of medical errors used to establish the possible fault and indemnity for the physician to pay.

A case report of systemic capillary leak syndrome (Clarkson's disease)

Systemic capillary leak syndrome (SCLS) is a very rare disorder also known as Clarkson's disease. The condition is characterized by recurrent episodes of severe capillary hyperpermeability resulting in severe hemoconcentration, hypoalbuminemia, hypovolemia and shock. We describe a 41-year-old previously healthy man who was admitted to hospital on several occasions with rapidly developing hypovolemic shock accompanied by extreme hemoconcentration and hypoalbuminemia. Our case is similar to other reports describing patients with SCLS where the initial suspicions have been pointing towards septic shock. He received a combination of prophylactic treatment with theophylline, beta-agonists, immunoglobulins and statins but eventually died after a severe episode of SCLS that ended with recurrent cardiac arrest. Clinical autopsy revealed pulmonary edema and acute and chronical organic fluid overload. SCLS should be kept in mind when treating patients suffering from attacks of severe idiopathic edema and mimics recurrent septic shock where no pathogen is found. The pathogenesis is unknown and the attacks may be lethal.

長期経過後に遺伝性血管性浮腫と診断された反復性咽喉頭顔面浮腫例

The autosomal dominant disorder hereditary angioedema (HAE) causes recurrent subcutaneous or submucosal edema at any body site due to trauma, mental or physical stress, infection, or cold stimulation, making laryngeal edema potentially life-threatening. We report a case of recurrent laryngopharyngofacial edema diagnosed as HAE only after long-term follow-up. A 20-year-old woman seen for edema of the face and larynx suffered recurrent acute episodes of the face, throat, and trunk edema and was treated for idiopathic recurrent edema. Life-threatening laryngeal edema a year later resulted in life-saving blind nasal emergency-room intubation. She was eventually diagnosed with HAE based on low serum C1-inhibitor activity and a lower C4 complement 5 years after her first admission. Thereafter, her life-threatening edema necessitated tracheotomy. She is now treated daily with 1500 mg of tranexamic acid for prophylaxis. HAE must be detected as early as possible, which necessitates extensive personel interviews with the subject and family members if possible. Greater awareness of HAE among health-care professionals and patients would also be useful.

Successful Medical Treatment of Blepharochalasis: A Case Series

ABSTRACTIntroduction: Blepharochalasis describes recurrent attacks of idiopathic transient painless oedema in the adnexal tissue of the orbit with the most severe reaction in the skin and orbicularis region. This may produce permanent tissue changes associated with thinning of the eyelid skin. Previous reviews have concentrated on surgical correction of the excess skin and orbicularis created by the condition. There has, as yet, been no report of successful medical management. Patients and Methods: We report here on 4 males and 2 females aged between 37 and 78 years. Systemic acetazolamide (initially 250 mg SR OD), was used in combination with a topical steroid (hydrocortisone cream). Results: All 6 patients achieved relief of their symptoms, with decreased incidence of occurrence and duration of episode if not complete resolution. Conclusion: Oral Acetazolamide in combination with topical hydrocortisone provides effective relief of the periorbital oedema associated with blepharochalasis. In our short series, the cases were improved either with medical therapy alone or in combination with surgery. Relapses following surgery were diminished as a result of prior medical therapy.

A case of adult acute idiopathic scrotal edema

A 40-year-old man presented to a hospital emergency department with acute-onset, bilateral, painless swelling of the scrotum, which had developed progressively over the previous 12 h. He was physically well with no remarkable medical history, and was not taking any medication. He had no history of allergies or trauma (including insect bites to the genitalia), no urinary symptoms, and was not sexually active. Physical examination, assessment of erythrocyte sedimentation rate, white blood cell count, renal function panel, urine microscopic analysis, urine cultures, transillumination, and scrotal ultrasonography. Acute idiopathic scrotal edema. The patient received expectant management and treatment with an NSAID to relieve his inflammation. He was discharged from hospital and his symptoms resolved within 72 h of onset of treatment.

La bourse aiguë de l’enfant : corrélations radiocliniques

Paediatric surgeons and urologists are often asked to evaluate boys with acute scrotal pain and inflammation. Although, there is much aetiology for this syndrome: testicular torsion, appendicular testicular torsion, epididymo-orchitis, hernia, hydrocele, trauma, Henoch-Schonlein purpura, idiopathic scrotal edema. However, testicular torsion should be at the top of the list because of the medico legal aspects. It is the one diagnosis that must be made accurately and rapidly, if there is any hope for testicular salvage. Color Doppler ultrasound scan can reliably identify those children, who required exploration and spare medical causes. The purpose of this article is to update/review the appropriate evaluation and management of the acute scrotum and to guide the clinician in distinguishing testicular torsion from the other conditions that commonly mimic this surgical emergency.

Idiopathic edema: state of the art

In this article we will try to highlight recent advances in the study of this mysterious problem as idiopathic edema (IE), exposing the most common myths of the disease. Idiopathic edema - a syndrome that is excess weight gain, which has no known cause. Other terms to describe this state is: "cyclic and periodic swelling," "syndrome fluid retention" and "orthostatic edema."

Dengue Hemorrhagic Fever Complicated with Acute Idiopathic Scrotal Edema and Polyneuropathy

We report a case of an adult with dengue hemorrhagic fever who developed acute idiopathic scrotal edema and glove-and-stocking polyneuropathy. A 54-year-old man who had fever, chills, bone pain, and skin rash for 4 days was admitted. We diagnosed dengue hemorrhagic fever because of fever, gum bleeding, thrombocytopenia, and hemoconcentration, and confirmed the diagnosis by serology. The patient had scrotal and penile edema and distal limb numbness with a glove-and-stocking distribution. After supportive care, the scrotal edema and other symptoms subsided. Patients with dengue hemorrhagic fever may develop scrotal edema caused by plasma leakage.

Primary and secondary lymphoedema in male patients with oedema in lower limbs

Objective: The purpose of this prospective study was to evaluate patients with clinically diagnosed lymphoedema of the lower extremities. The proportions of primary and secondary lymphoedema, the possible aetiologic factors and the concomitance of chronic venous diseases and lymphoedema were focused on. Method: The male patients who attended our outpatient clinic during 2000 and 2004 were evaluated. In all, 160 male patients with 5 cm circumference difference at calf level between two lower extremities or with clinically diagnosed bilateral leg oedema were enrolled. All patients underwent duplex venous ultrasonography and lymphoscintigraphy. Venography was performed in 12 patients with normal lymphoscintigraphy and ultrasonography. Results: The age distribution was between 20 and 54 years (mean ± SD; 22.9 ± 4.3). Among 160 patients, 70.0% had lymphoedema, while 7.5% had chronic venous insufficiency, 3.75% chronic deep venous thrombosis, 7.5% concomitant venous disease and lymphatic obstruction, and 7.5% idiopathic oedema. In the last 3.75% the pathology was Klippel–Trenaunay syndrome. Of the primary lymphoedema patients (16.25%), 18 were praecox, six tarda and two were congenital types. Conclusion: In young male patients, the causes of secondary lymphoedema are lymphadenectomy, neoplastic metastasis, cellulitis, lymphangitis, etc. Further techniques confirmed the clinical diagnosis of lymphoedema in 77.5% (sum of lymphoedema and concomitant disease) of all patients. With these findings lymphoedema can be diagnosed clinically, and further diagnostic techniques can be reserved unless treatment is effective.

Approach to Leg Edema of Unclear Etiology

A common challenge for primary care physicians is to determine the cause and find an effective treatment for leg edema of unclear etiology. We were unable to find existing practice guidelines that address this problem in a comprehensive manner. This article provides clinically oriented recommendations for the management of leg edema in adults. We searched on-line resources, textbooks, and MEDLINE (using the MeSH term, "edema") to find clinically relevant articles on leg edema. We then expanded the search by reviewing articles cited in the initial sources. Our goal was to write a brief, focused review that would answer questions about the management of leg edema. We organized the information to make it rapidly accessible to busy clinicians. The most common cause of leg edema in older adults is venous insufficiency. The most common cause in women between menarche and menopause is idiopathic edema, formerly known as "cyclic" edema. A common but under-recognized cause of edema is pulmonary hypertension, which is often associated with sleep apnea. Venous insufficiency is treated with leg elevation, compressive stockings, and sometimes diuretics. The initial treatment of idiopathic edema is spironolactone. Patients who have findings consistent with sleep apnea, such as daytime somnolence, loud [corrected] snoring, or neck circumference >17 inches, should be evaluated for pulmonary hypertension with an echocardiogram. If time is limited, the physician must decide whether the evaluation can be delayed until a later appointment (eg, an asymptomatic patient with chronic bilateral edema) or must be completed at the current visit (eg, a patient with dyspnea or a patient with acute edema [<72 hours]). If the evaluation should be conducted at the current visit, the algorithm shown in Figure 1 could be used as a guide. If the full evaluation could wait for a subsequent visit, the patient should be examined briefly to rule out an obvious systemic cause and basic laboratory tests should be ordered for later review (complete blood count, urinalysis, electrolytes, creatinine, blood sugar, thyroid stimulating hormone, and albumin).

Acuut idiopathisch scrotaal oedeem bij kinderen

Acute idiopathic scrotal edema in children Acute idiopathic scrotal edema is an acute, painless scrotal swelling, often accompanied by scrotal erythema. Acute idiopathic scrotal edema is commonly observed in prepuberal boys. Its etiology is still unknown. The patients are in good health and blood and urine analysis is negative. Scrotal ultrasonography reveals typical thickening of the scrotal skin and normal bloodflow to the testes. Before the diagnosis of acute „idiopathic” scrotal edema may be made, other urological and surgical causes of an acute scrotal swelling have to be excluded first. Acute idiopathic scrotal edema does not require treatment since clinical features resolve spontaneously in 12-72 hours. Recurrences are rare.

Acute idiopathic scrotal oedema: incidence, manifestations and aetiology.

Twenty-four children with a total of 31 episodes of acute idiopathic scrotal oedema (AISO) were assessed during a 5 year period. AISO accounted for 30 per cent of all admissions with acute scrotal pathology in this period and was the final diagnosis in 69 per cent of cases in those presenting under the age of 10 years. Although presentation was with unilateral (48 per cent) or bilateral (52 per cent) AISO, considerable overlap between these two groups occurred. Five patients (21 per cent) had recurrent attacks. Fourteen boys (60 per cent) had a history of allergy or had allergic manifestations at presentation compared with an incidence of allergy of 28 per cent in 42 controls (P less than 0.05). AISO is the commonest cause of the 'acute scrotum' in boys under the age of 10 years and is probably allergic in origin.